Provider Demographics
NPI:1528454238
Name:ROSS-LI, SHELLEY KATHERINE (MD)
Entity type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:KATHERINE
Last Name:ROSS-LI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHELLEY
Other - Middle Name:KATHERINE
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2305 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4691
Mailing Address - Country:US
Mailing Address - Phone:812-949-0405
Mailing Address - Fax:
Practice Address - Street 1:2305 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4691
Practice Address - Country:US
Practice Address - Phone:812-949-0405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA169120208000000X
CAA169120208M00000X
IN01087235A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01087235AOtherSTATE MEDICAL LICENSE
CA1182543OtherAMERICAN BOARD OF PEDIATRICS
CAA169120OtherSTATE MEDICAL LICENSE